BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and...BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.展开更多
BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The s...BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE)in combination with continuous renal replacement therapy(CRRT) (PE+CRRT) for AFLP still needs evaluation.METHODS: Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.RESULTS: All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results and they were cured and discharged home after the treatment One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.CONCLUSION: PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.展开更多
Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plas...Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF.Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE.Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006).Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.展开更多
Continuous arterovenous hemifiltration (CAVH) is an effective and safe method which can remove excess water and solute in the body for treating acute and chronic renal failure with hypervolemia and heart failure. In t...Continuous arterovenous hemifiltration (CAVH) is an effective and safe method which can remove excess water and solute in the body for treating acute and chronic renal failure with hypervolemia and heart failure. In this paper the nursing management of CAVH in 15 patients is discussed.The important points in CAVH nursing are as follows:Select hemofilter of high quality, observe closely the working condition of hemofilter and its tubes, prevent coagulation of blood in the tube, warm the back-infused blood to 30℃, monitor the dosage of heparin and control fluid intake and the diet.展开更多
Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF...Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF patients who received renal support between December 1978 and December 1998 were involved in this study.Of them,101(52.3%)were treated with CRRT(CRRT group),and 92(47.7%)with IHD(IHD group).Results Sixty(59.4%)patients in the CRRT group got through the acute phase of disease and 41 (40.6%)patients did not survive while in the IHD group 59(64.1%)patients survived and 33(35.9%)patients did not.No significant difference in survival rate was found between the two groups.24 of 64 patients(37.5%)in the CRRT group with multiple organ dysfunction syndrome(MODS)survived,while in the IHD group,8 out of 44(27.3%)survived,their survival rate was much lower than that in the CRRT group.Patients in CRRT group were more severely iii,as manifested by lower mean arterial pressure,higher APACHE Ⅱ score,more dysfunctioned organs and requiring mechanical ventilation and vasopressor support as compared with patients in the IHD group,CRRT was found to improve hemodynamic stability with a better fluid balance and control of biochemical status,increased nutritional intake and a shorter duration of acute renal failure(P ＜ 0.05).Conclusion CRRT perhaps may be the best choice in the treatment of severe ARF patients,for it can offer several distinct advantages compared to IHD.These may contribute to improving the survival rate of ARF patients,particularly those that are critically ill patients.展开更多
文摘BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.
基金supported by grants from the National Scientific and Technological Major Project of China (2011ZX10004-901 and 2013ZX10004904)the National Science and Technology Major Project (2012ZX10002006)the Scientific Research Fundation of the Education Department,Zhejiang Province (N20120081)
文摘BACKGROUND: Acute fatty liver of pregnancy (AFLP) in the third trimester or early postpartum period can lead to fatal liver damage. Its traditional therapy is not very effective in facilitating hepatic recovery. The safety and effect of plasma exchange (PE)in combination with continuous renal replacement therapy(CRRT) (PE+CRRT) for AFLP still needs evaluation.METHODS: Five AFLP patients with hepatic encephalopathy and renal failure were subjected to PE+CRRT in our department from 2007 to 2012. Their symptoms, physical signs and results were observed, and all relevant laboratory tests were compared before and after PE+CRRT.RESULTS: All the 5 patients were well tolerated to the therapy. Four of them responded to the treatment and showed improvement in clinical symptoms/signs and laboratory results and they were cured and discharged home after the treatment One patient succeeded in bridging to transplantation for slowing down hepatic failure and its complications process after2 treatment sessions. Intensive care unit stay and hospital stay were 9.4 (range 5-18) and 25.0 days (range 11-42), respectively.CONCLUSION: PE+CRRT is safe and effective and should be used immediately at the onset of hepatic encephalopathy and/or renal failure in patients with AFLP.
基金supported by grants from the National Natural Science Foundation of China(NO.82270690)to Huimin Yithe National Natural Science Foundation of China(NO.82200732)to Xuxia Wei+1 种基金the Guangdong Natural Science foundation(NO.2022A1515012519)to Xuxia Weithe Guangdong Natural Science foundation(NO.2022A1515011919)to Huimin Yi.
文摘Background and aim:Hepatitis B virus(HBV)-related gestational acute-on-chronic liver failure(ACLF)is a severe condition with limited treatment options.This study aimed to evaluate the efficacy and ideal timing of plasma exchange and continuous renal replacement therapy(CRRT)in managing pregnant women with HBV-related ACLF.Methods:This study retrospectively analyzed 51 eligible patients with HBV-related gestational ACLF between 2009 and 2020.Patients admitted to the study were divided into a conventional treatment group and a new treatment group according to whether they received the new management protocol,which included more aggressive plasma exchange(PE)and CRRT strategies.All 19 pregnant women with hepatic encephalopathy(HE)were divided into an early treatment group and a non-early treatment group according to whether PE therapy was initiated within three days.Our study had two primary objectives.Firstly,we aimed to evaluate the impact of PE and CRRT on puerperal survival.Secondly,we sought to assess the effects of early PE and CRRT regimens on puerperal survival in women with HE.Results:The levels of total bilirubin on the second day postpartum(D3),the third day postpartum(D4),and the fifth day postpartum(D6)were significantly lower in the new treatment group compared to the conventional treatment group(P=0.02,0.01,and 0.02,respectively).The ALT of D3 was significantly elevated in the new treatment group compared to the conventional treatment group(P=0.02).The incidence of HE overall increased from prenatal to postpartum D4,peaked on D4,and then gradually decreased from the fourth day postpartum(D5)(P=0.027).The first week after delivery revealed a significant difference in survival rate between the two groups,the conventional treatment group had statistically higher mortality rates compared to the new treatment group(P=0.002).Similarly,the entire puerperal period mortality rate of the conventional treatment group was statistically higher than the new treatment group(P=0.002).Moreover,among all patients with HE,the non-early treatment group showed significantly higher puerperal mortality rates compared to the early treatment group(P=0.006).Conclusions:Early PE and CRRT conducted within three days post-childbirth,enhance puerperal prog-nosis for HBV-related gestational ACLF.
文摘Continuous arterovenous hemifiltration (CAVH) is an effective and safe method which can remove excess water and solute in the body for treating acute and chronic renal failure with hypervolemia and heart failure. In this paper the nursing management of CAVH in 15 patients is discussed.The important points in CAVH nursing are as follows:Select hemofilter of high quality, observe closely the working condition of hemofilter and its tubes, prevent coagulation of blood in the tube, warm the back-infused blood to 30℃, monitor the dosage of heparin and control fluid intake and the diet.
文摘Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF patients who received renal support between December 1978 and December 1998 were involved in this study.Of them,101(52.3%)were treated with CRRT(CRRT group),and 92(47.7%)with IHD(IHD group).Results Sixty(59.4%)patients in the CRRT group got through the acute phase of disease and 41 (40.6%)patients did not survive while in the IHD group 59(64.1%)patients survived and 33(35.9%)patients did not.No significant difference in survival rate was found between the two groups.24 of 64 patients(37.5%)in the CRRT group with multiple organ dysfunction syndrome(MODS)survived,while in the IHD group,8 out of 44(27.3%)survived,their survival rate was much lower than that in the CRRT group.Patients in CRRT group were more severely iii,as manifested by lower mean arterial pressure,higher APACHE Ⅱ score,more dysfunctioned organs and requiring mechanical ventilation and vasopressor support as compared with patients in the IHD group,CRRT was found to improve hemodynamic stability with a better fluid balance and control of biochemical status,increased nutritional intake and a shorter duration of acute renal failure(P ＜ 0.05).Conclusion CRRT perhaps may be the best choice in the treatment of severe ARF patients,for it can offer several distinct advantages compared to IHD.These may contribute to improving the survival rate of ARF patients,particularly those that are critically ill patients.
